原发性肛管直肠恶性黑色素瘤27例报告

背景与目的:肛管直肠恶性黑色素瘤在临床上极为少见,除外科手术外,缺乏有效的治疗手段,而外科治疗方式的选择也一直存在争议。本研究旨在通过对该病临床特征、治疗方式和患者生存情况的分析,探讨肛管直肠恶性黑色素瘤的诊断和治疗。方法:收集过去16年本院收治的所有肛管直肠恶性黑色素瘤患者,分析其临床特点和治疗方式。结果:共收集肛管直肠恶性黑色素瘤27例,平均年龄55.38岁,女性略占多数,73.0%的患者曾被误诊,肿瘤最大径平均为3.76cm,淋巴结转移(72.7%)较脉管/神经侵犯(22.7%)常见,但仅脉管/神经侵犯和远处转移与预后有相关性。接受扩肛广泛切除者术后局部复发率高,而腹会阴联合切除术(abdominoperineal resection,APR)者无局部复发,手术方式与预后无相关性。结论:肛管直肠恶性黑色素瘤以女性略占多数,该病易被误诊,脉管/神经侵犯和远处转移者预后差。APR手术在肛管直肠恶性黑色素瘤的治疗中仍是一个重要选择。

Clinical characteristics and management of anorectal melanoma-a report of 27 cases

Background and purpose:Anorectal melanoma is a rare condition. Its clinical feature is not clearly understood. Surgical management of this disease is still controversial. This study is intended to find the treatment methods and survival. Methods:Anorectal melanoma treated in Shanghai Cancer Hospital in the past 20 years were reviewed. Clinical features, surgical procedure, local recurrence and survival were analyzed.Results:27 anorectal melanoma patients were collected. Mean age of diagnosis is 55.38. The Misdiagnosis rate was 73.8%. Average diameter of primary tumor is 3.76 cm. Lymph node metastasis is more frequent than vessel invasion. However, only vessel/nerve invasion and distant metastasis are statistically correlated with survival. Local wide resection has higher local recurrence rate than abdominoperineal resection. Types of operation is not correlated with survival.Conclusions:Misdiagnosis of anorectal melanoma should be given attention. Vessel/nerve invasion and distant metastasis are correlated with survival, while surgical procedure is not. Abdominoperineal resection has an important role in the management of anorectal melanoma.